摘要
目的调查我国三级综合医院加速康复外科(enhanced recovery after surgery,ERAS)开展现状及其障碍因素。方法采用自行设计的“三级医院加速康复外科开展现状及障碍因素调查表”,于2022年5–6月采用便利抽样法抽取全国21个省份的77所三级综合医院进行问卷调查。ERAS开展现状调查表主要包括开展科室、开展的项目等,术前、术中、术后三个维度共25条目,各答案均由“从不”到“总是”5个选项构成、分别计1~5分,得分越高说明该项目开展情况越好;ERAS开展的障碍因素及相关建议调查表中,障碍因素主要包括医院层面、患者及照护者层面两个维度共10项条目,各答案由“不同意”到“非常同意”5个选项构成、分别计1~5分,得分越高说明该障碍因素越重要。结果77所三级医院中73所(94.8%)开展了ERAS项目,开展最佳的条目为术前宣教(4.73±0.51)、深静脉血栓的防治(4.55±0.71)及术后随访(4.40±0.81);开展较差的条目为术前预康复(2.71±1.40)、术前口服含碳水化合物的饮品(3.03±1.49)及术后早期活动(3.04±1.22)。ERAS开展的障碍因素前三位为激励制度不完善、医护积极性较差(3.21±0.93),未形成具体疾病的临床指导方针(3.16±1.06)及多学科团队协作经验不完善(2.98±1.17)。结论ERAS在我国三级综合医院开展率较高,临床实施及推广仍面临诸多障碍。
Objective To investigate the status of and obstacles to the implementation of enhanced recovery after surgery(ERAS)in tertiary-care general hospitals in China.Methods Questionnaire on the Current Status of and Barriers to the Implementation of ERAS in Tertiary-Care Hospitals,a self-developed questionnaire,was used to conduct a survey of 77 tertiary hospitals from 21 provinces across China between May 2022 and June 2022.The participating hospitals were selected by convenience sampling.The questionnaire on the current implementation status of ERAS was mainly focused on the departments involved and the ERAS programs implemented,incorporating a total of 25 items of three dimensions,preoperative,intraoperative,and postoperative.The answer to each question consisted of 5 options from“never”to“always”,which corresponded to 1 to 5 points on the scoring scale,with the higher scores indicating better implementation of the program concerned.In the questionnaire on barriers to ERAS implementation and recommendations,10 items of two dimensions,including hospital management,and patient and caregiver,were concerned with the barriers to implementation.The answer to each question consisted of 5 options from“disagree”to“strongly agree”,which corresponded to 1 to 5 points on the scoring scale,with the higher scores indicating the greater importance of the barriers.Results ERAS programs were implemented in 73(94.8%)hospitals.The best-implemented items were preoperative education(4.73±0.51),prevention and treatment of deep vein thrombosis(4.55±0.71),and postoperative follow-up(4.40±0.81).The items of poor implementation status were preoperative prehabilitation(2.71±1.40),preoperative oral carbohydrate drinks(3.03±1.49),and early ambulation after surgeries(3.04±1.22).The main obstacles to ERAS implementation included a lack of effective incentive systems,poor motivation among the medical and nursing staffs(3.21±0.93),a lack of disease-specific clinical implementation pathways(3.16±1.06),and a lack of experience
作者
汪夏云
朱晓萍
吴茜
WANG Xiayun;ZHU Xiaoping;WU Qian(Jiangxi University of Technology,Nanchang 330000,China;Nursing Department,Shanghai Tenth People's Hospital,Tongji University,Shanghai 200072,China)
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2023年第5期1000-1005,共6页
Journal of Sichuan University(Medical Sciences)
基金
上海市卫健委临床研究项目(No.20204Y0171)
上海市申康医疗中心、上海市市级医院诊疗技术推广及优化管理项目(No.SHDC12022621)资助。
关键词
加速康复外科
三级医院
开展现状
障碍因素
Enhanced recovery after surgery
Tertiary hospital
Implementation status
Obstacles
